胸腺肿瘤诊断和治疗的有关问题(附73例报告)

Problems on the Diagnosis and Treatment of Thymus Tumors (Report of 73 Patients)

目的 :探讨良性胸腺瘤复发原因及胸腺瘤新的分类方法、恶性胸腺肿瘤的影像学诊断特点、手术方式、合并重症肌无力患者的处理、胸腺肿瘤术后治疗等。方法 :1975年 1月～ 1995年 12月手术治疗的 73例胸腺肿瘤和囊肿。结果 :总结了恶性胸腺瘤的CT特征 ,恶性胸腺肿瘤应争取全胸腺及脂肪组织切除 ,重视合并重症肌无力的围手术期处理、恶性和潜在恶性胸腺瘤术后应放疗 ,复发病例再手术仍能获得较好疗效。结论 :提出了一种胸腺瘤新的分类方法 ,即良性、潜在恶性、恶性三类 ,较为合理地解释良性胸腺瘤复发原因 。

Objective:To summarize our experience in the diagnosis and treatment of thymus tumors.Methods:Retrospective analysis of the cases was studied in our hospital from January 1975 to December 1995.Result:Among a total of 73 cases of thymus tumors and cysts,accountingfor 29.2% of all the mediastinal tumors, 62 cases were thymoma (malignant 15 cases, potential malignant 16 cases, benign 31 cases), 2 cases thymus squamous carcinoma, 1 case sarcomatous carcinoid, 1 case carcinoid, 2 cases thymus cystic teratoma and 5 cases thymus cysts. The overall 5 year survival was 82.9%, with 5 year survivals for benign, potential malignant, malignant thymoma and thymus carcinoma being 93.5%, 87.5%, 53.5% and 25%, respectively.Conclusion:Based on the relationship with the surrounding tissues, the tumors can be classified into benign, potential malignant and malignant, which is of great help in explaining the reported recurrence of the so called benign thymomas and in guiding the postoperative management. Some features on CT, such as border irregularity, lobulated, no sharp border to adjacent tissue, are of value in preoperative diagnosis. Total thymectomy and removal of the surrounding fat tissue should be tried for malignant thymomas. For patients complicated by myasthenia gravis, the perioperative management is of vital importance. For malignant and potential malignant thymomas, postoperative radiotherapy should be given. For recurred cases, reoperation is still effective.